Organic impotence refers to the inability to obtain an erection firm enough for vaginal penetration, or the inability to sustain the erection until completion of intercourse. In contrast to psychogenic impotence, which is impotence caused by anxiety, guilt, depression, or conflict around various sexual issues, organic impotence, the more common of the two categories of erectile dysfunction, is caused by physical problems. Ten to 20% of middle-aged men and a much higher percentage of elderly men are impotent. Aside from its importance as a common and distressing sexual problem, organic impotence may herald important medical problems.

But if the blood flow is weak here, it is highly likely that it is also weak in arteries supplying the heart, raising the risk of a heart attack. In fact, some studies suggest that women with heart disease may also suffer sexual dysfunction: the clitoris, like the penis, is a vascular organ, and also relies on healthy blood flow for successful orgasms.

Male/Female Perceptions and Influences. The diagnosis of erectile dysfunction may be understood as the presence of a condition limiting choices for sexual interaction and possibly limiting opportunity for sexual satisfaction. The impact of this condition depends very much on the dynamics of the relationship of the individual and his sexual partner and their expectation of performance. When changes in sexual function are perceived by the individual and his partner as a natural consequence of the aging process, they may modify their sexual behavior to accommodate the condition and maintain sexual satisfaction. Increasingly, men do not perceive erectile dysfunction as a normal part of aging and seek to identify means by which they may return to their previous level and range of sexual activities. Such levels and expectations and desires for future sexual interactions are important aspects of the evaluation of patients presenting with a chief complaint of erectile dysfunction.
The association between low testosterone and ED is not entirely clear. Although these 2 processes certainly overlap in some instances, they are distinct entities. Some 2-21% of men have both hypogonadism and ED; however, it is unclear to what degree treating the former will improve erectile function. [17] About 35-40% of men with low testosterone see an improvement in their erections with testosterone replacement; however, almost 65% of these men see no improvement. [15]
Anxiety is particularly pernicious. It triggers the fight-or-flight reflex that sends blood away from the central body, including the penis, and out to the limbs for self-defense or escape. Less blood in the central body means less blood available for erection. Erection dissatisfaction is upsetting, but try to accept it. It’s normal. And when men become anxious about it, erections become less likely.

An analysis of 14 studies involving more than 90,000 patients with ED confirmed the relation between ED and an increased risk of cardiovascular events and mortality. [56] Compared with patients without ED, those with ED had a 44% increased risk of cardiovascular events, a 25% increased risk of all-cause mortality, a 62% increased risk of MI, and a 39% increased risk of cerebrovascular events. Treatment of ED, either through lifestyle interventions or by pharmacologic means, may improve prognosis and reduce risk.


Diet can also affect a man’s ability to achieve or maintain an erection. As stated, men who indulge in alcohol may have trouble with erections, but men who have poor diets, suffer from diabetes, or who are overweight can also restrict blood flow to the penis or suffer from poor body image. All of these factors, especially when combined, can lead to erectile dysfunction.
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High cholesterol and triglyceride levels increase the risk of cardiovascular disease. Getting your cholesterol and triglyceride levels in an optimal range will help protect your heart and blood vessels. Cholesterol management may include lifestyle interventions (diet and exercise) as well as medications to get your total cholesterol, LDL, HDL, and triglycerides in an optimal range.
Erectile dysfunction (ED) is commonly called impotence. It’s a condition in which a man can’t achieve or maintain an erection during sexual performance. Symptoms may also include reduced sexual desire or libido. Your doctor is likely to diagnose you with ED if the condition lasts for more than a few weeks or months. ED affects as many as 30 million men in the United States.
The 4 ED medicines we prescribe – Generic sildenafil 20 mg, Viagra (also sildenafil), Cialis (Tadalafil), or Levitra (Vardenafil) - are generally safe but shouldn’t be used as recreational drugs. They’re meant to treat a medical condition and can cause serious side effects including but not limited to an erection lasting more than four hours, sudden loss of vision in one or both eyes, and sudden decrease or loss of hearing.

The male erectile response is a vascular event initiated by neuronal action and maintained by a complex interplay between vascular and neurological events. In its most common form, it is initiated by a central nervous system event that integrates psychogenic stimuli (perception, desire, etc.) and controls the sympathetic and parasympathetic innervation of the penis. Sensory stimuli from the penis are important in continuing this process and in initiating a reflex arc that may cause erection under proper circumstances and may help to maintain erection during sexual activity.
One study examined the role of testosterone supplementation in hypogonadal men with ED. These men were considered nonresponders to sildenafil, and their erections were monitored by assessing nocturnal penile tumescence (NPT). After these men were given testosterone transdermally for 6 months, the number of NPTs increased, as did the maximum rigidity with sildenafil. [18] This study suggests that a certain level of testosterone may be necessary for PDE5 inhibitors to function properly.
Your erection problems may be putting a strain on your relationship. You may have stopped touching and cuddling your partner, scared that it could lead to sex - and then to disappointment because you cannot get hard. You may have found it has led to regular arguments. At its worst, erection problems can lead to the breakdown of relationships. So it is vitally important to talk things over with your partner.
The causes of erectile dysfunction include aging, high blood pressure, diabetes mellitus, cigarette smoking, atherosclerosis (hardening of the arteries), depression, nerve or spinal cord damage, medication side effects, alcoholism or other substance (drug) abuse, pelvic surgery including radical prostatectomy, pelvic radiation, penile/perineal/pelvic trauma such as pelvic fracture, Peyronie's disease (a disorder that causes curvature of the penis and sometimes painful erections), and low testosterone levels.
In some cases, nocturnal penile tumescence testing is performed to find out whether the man has erections while asleep. Healthy men usually have about four or five erections throughout the night. The man applies a device to the penis called a Rigiscan before going to bed at night, and the device can determine whether he has had erections. (If a man is able to have normal erections at night, this suggests a psychological cause for his impotence.)
Obviously, there are worse problems than a guy saying "I love you" too often, but if it's a problem, it sounds like the two of you need to have a long conversation. You need to understand why he likes to say it so much: Is it because he's insecure or hoping to comfort you or just breathlessly in love? (Or some combination of the three?) And he needs to understand how it makes you feel. So, if it really bothers you, tell him why.

ED can be caused by either physical and/or psychological factors like stress, anxiety, or depression. Importantly, ED can be the first sign of heart or other health conditions, including cardiovascular disease and diabetes. We offer the optional order of a lab test to investigate whether you might have more serious underlying health problems. Our doctors can order investigative labs in all the states we operate in apart from AZ, NY, NJ and RI. You’ll need to go to a Quest Diagnostics center to have these tests done. When we get the test results back, we can help you understand what they mean.

Sexual stimulation causes the release of neurotransmitters from cavernosal nerve endings and relaxation factors from endothelial cells lining the sinusoids. NOS produces NO from L-arginine, and this, in turn, produces other muscle-relaxing chemicals, such as cGMP and cyclic adenosine monophosphate (cAMP), which work via calcium channel and protein kinase mechanisms (see the image below). This results in the relaxation of smooth muscle in the arteries and arterioles that supply the erectile tissue, producing a dramatic increase in penile blood flow.


ED may occur with or without other sexual dysfunction, including decreased libido (decreased interest in sexual activity), orgasmic dysfunction (troubles achieving an orgasm/climax), and ejaculatory dysfunction (problems with the fluid released during sex, including lack of ejaculation [anejaculation], small volume ejaculate, ejaculation that occurs too quickly [premature ejaculation], ejaculate that goes backward into the bladder [retrograde ejaculation] and pain with ejaculation).

For many men, there is no direct factor involved in erectile dysfunction other than the natural process or aging. As men age, the testosterone hormone decreases in productivity and circulation. Basically, the body is saying that the man has done his job, especially if he has had children. During this time of drawdown on testosterone, men may experience weaker erections, more difficulty in achieving erections, and more difficulty in maintaining erections.
The pathogenesis of organic ED is related to dysfunction of the endothelium. Endothelial cells can become injured through a variety of mechanisms, most of which cause oxidative stress on the tissues. Many of these causes of oxidative stress are related to lifestyle issues which lead to hypertension, diabetes and dyslipidaemia (figure 1). Endothelial cell dysfunction results in reduction of endothelium-dependent vasorelaxation as well as increased adhesion of leukocytes to the endothelium. Endothelial cell injury then leads to a variety of sequelae, including ED, other types of vasoconstriction, atherosclerosis and thrombus formation.18
Poor sleep patterns can be a contributing factor for erectile dysfunction, Mucher says. One review published in the journal Brain Research emphasized the intricate relationship between the level of sex hormones like testosterone, sexual function, and sleep, noting that testosterone levels increase with improved sleep, and lower levels are associated with sexual dysfunction. Hormone secretion is controlled by the body’s internal clock, and sleep patterns likely help the body determine when to release certain hormones. 
He can follow the common general physical advice: Sleep well, eat well, exercise, and moderate or abstain from drinking and drugs. He can also visit the doctor to see if there’s any medical reason for his condition (anything from heart disease to diabetes and obesity). Sometimes, impotence is a side effect of prescription drugs. If his anxiety is extreme, it never hurts to see a professional therapist. Whenever there’s even a chance of a medical problem, my advice is always: Why not check with a professional?
But the main challenge to finding the best ED drug for you may turn out to be health insurance rules—not biochemistry. It's a common practice among insurers to limit the number of pills you can obtain per month. After you hit your limit, the out-of-pocket cost for a single pill can be as high as $20. "The main obstacle in my practice is the cost," Dr. Liou says. You'll need to work with your doctor to get the pill you need at a price you can afford.
You may already know that lots of hard drugs — like cocaine, heroin, or Oxycontin — can cause sexual problems (though, quite frankly, if you're on cocaine, heroin, or Oxycontin, you have many more pressing concerns to deal with than getting dirrrty). But did you know that sometimes, even pot can inhibit erections? And you thought weed was just a harmless way to enjoy the musical stylings of Pink Floyd. Who knew it could actually mess with one's own pink floyd?

The role of the endothelium in ED has been noted for a number of years and the overlapping of ED and other conditions, especially coronary heart disease, CVD, affecting endothelial function/dysfunction, is clearly present. The endothelial cell is now known to affect vascular tone and impact the process of atherosclerosis, and impacting ED, CVD and peripheral vascular disease.16
The most important organic causes of impotence are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but can often be helped. In psychological impotence, there is a strong response to placebo treatment.
Trauma to the pelvic blood vessels or nerves can also lead result in ED. Bicycle riding for long periods has been implicated as an etiologic factor; direct compression of the perineum by the bicycle seat may cause vascular and nerve injury. [37] On the other hand, bicycling for less than 3 hours per week may be somewhat protective against ED. [37] Some of the newer bicycle seats have been designed to diminish pressure on the perineum. [37, 38]
The user should stop using the vacuum pump if pain occurs... Use of a vacuum pump may bruise or rupture the blood vessels either immediately below the surface of the skin or within the deep structures of the penis or scrotum, resulting in hemorrhage and/or the formation of a hematoma. There is now sufficient information available regarding the risks, benefits, and use of vacuum pumps.

Sildenafil (Viagra) was the first oral phosphodiesterase type 5 (PDE5) inhibitor approved by the FDA in the United States for the treatment of erectile dysfunction (it is not approved for women). Sildenafil inhibits PDE5, which is an enzyme that destroys cGMP. By inhibiting the destruction of cGMP by PDE5, sildenafil allows cGMP to accumulate. The cGMP in turn prolongs relaxation of the smooth muscle of the corpora cavernosa. Relaxation of the corpora cavernosa smooth muscle allows blood to flow into the penis resulting in increased engorgement of the penis. In short, sildenafil increases blood flow into the penis and decreases blood flow out of the penis.

The following products are considered to be alternative treatments or natural remedies for Erectile Dysfunction. Their efficacy may not have been scientifically tested to the same degree as the drugs listed in the table above. However there may be historical, cultural or anecdotal evidence linking their use to the treatment of Erectile Dysfunction.
Physical examination should include the assessment of male secondary sex characteristics, femoral and lower extremity pulses, and a focused neurologic examination including perianal sensation, anal sphincter tone, and bulbocavernosus reflex. More extensive neurologic tests, including dorsal nerve conduction latencies, evoked potential measurements, and corpora cavernosal electromyography lack normative (control) data and appear at this time to be of limited clinical value. Examination of the genitalia includes evaluation of testis size and consistency, palpation of the shaft of the penis to determine the presence of Peyronie's plaques, and a digital rectal examination of the prostate with assessment of anal sphincter tone.

Remember what I said before about how it's not you? Okay, sometimes it is you. But it's not that you're not sexy — it's that for men, as well as women, relationship problems (like fighting all the time, or having clashing expectations about where things are going) can severely mess up your sex drive and ability to become aroused. Which makes sense — if you're spending 90 percent of your time together fighting about whether you're going to move in, switching gears to make 10 percent of your time together into a sexy sex party is pretty damned difficult.
However, men are affected psychologically when it comes to achieving erections. For instance, if a man is with a woman for the first time, or even before he feels comfortable with her, he may suffer from performance anxiety. In such a situation, his mind and body are both saying yes, but then they become out of sync. The body is then saying yes, but the mind is filled with question. “Will I be able to perform?” “How long will I last?” “Am I big enough to satisfy her?” “Is she looking at that mole on my stomach?” All kinds of questions may be going through a man’s mind upon getting in bed, and these can be distracting, they can lead to self-doubt, and therefore, failure to achieve or maintain an erection.
Among their findings, the panel concluded that (1) the term "erectile dysfunction" should replace the term "impotence"; (2) the likelihood of erectile dysfunction increases with age but is not an inevitable consequence of aging; (3) embarrassment of patients and reluctance of both patients and health care providers to discuss sexual matters candidly contribute to underdiagnosis of erectile dysfunction; (4) many cases of erectile dysfunction can be successfully managed with appropriately selected therapy; (5) the diagnosis and treatment of erectile dysfunction must be specific and responsive to the individual patient's needs and that compliance as well as the desires and expectations of both the patient and partner are important considerations in selecting appropriate therapy; (6) education of health care providers and the public on aspects of human sexuality, sexual dysfunction, and the availability of successful treatments is essential; and (7) erectile dysfunction is an important public health problem deserving of increased support for basic science investigation and applied research.
Because impotence can be due to health problems that can affect the whole body, and because it can interfere with one’s quality of life, it is important to talk with your doctor if you have trouble attaining or maintaining an erection. With increasing discussion of impotence in the media, coupled with advances in treatment, men are now much more comfortable talking with their doctors about impotence. It is currently estimated that between 15 and 30 million men in the United States are affected by impotence (Source: NIDDK).
Three days after Michael was found to have a dangerously blocked coronary artery, surgeons inserted a stent to prop the artery open. Now he is keen to get more men going to their doctor to be checked up. "When it comes to sex, people keep things to themselves. But this is an easy way to catch heart problems at an early stage and treat them before the worst happens."
If you're regularly having trouble getting or maintaining erection and it's not situation specific (for instance, this happens whether you're with a partner or alone or watching porn or whatever), it could be a tip-off to a physiological problem. Diabetes, high cholesterol, high blood pressure, and cardiovascular issues can all present with erectile problems, says Paduch. That's because basically anything affecting your nerves or blood flow can impact your boners.
Erections are more complicated than you think. Your brain, nerves, heart, blood vessels, and a whole lot of hormones have to work together perfectly or nothing happens. It’s a lot to ask, and sometimes things break down. And while ED happens to most guys at some point in their lives, erectile dysfunction isn’t something you can just ignore and hope it goes away.
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